The Impact of Health Care Reform on Public Programs
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Transcript of The Impact of Health Care Reform on Public Programs
The Impact of Health Care Reform on Public Programs
Cindy MannCenter for Children and Families
Georgetown University Health Policy Institute
http://ccf.georgetown.edu
National Health Policy Conference
Academy Health
February 2-3, 2009
11%
29%
4%
55%
Public Programs’ Coverage Role Today (Non-elderly, 2007)
20%
11%
6%63%
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Children = 78.6 million
Individual Coverage
Employer-Sponsored Insurance
Medicaid/ Other Public
Uninsured
Adults = 182.8 million
NOTE: Does not include spending on SCHIPSOURCE: Kaiser Commission on Medicaid and the Uninsured, based on A Catlin et al, “National Health Spending in 2006: A Year of Change for Prescription Drugs,” Health Affairs 27(1)14-29, January/February 2008. Based on National Health Care Expenditure Data, CMS, Office of the Actuary.
Total National Spending(billions)
$2,106
$648 $660 $125
$217
Medicaid as a share of national health care spending:
Medicaid in the Health System, 2006
Income and Health Status of Medicaid and the Low-Income Privately Insured, 2002
Percent of Enrolled Adults:
Poor Health Conditions that
limit work
Fair or Poor Health
SOURCE: Coughlin et. al, “Assessing Access to Care Under Medicaid: Evidence for the National and Thirteen States,” Health Affairs 24(4):1073-1083. Based on a 2002 NSAF analysis for Kaiser Commission on Medicaid and the Uninsured.
Medicaid Low-Income andPrivately Insured
42%
28%
15%
15%
Income Levels of Uninsured, 2007
35%
29%
25%
11%
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.
Children = 8.9 million Adults = 36.1 million
Under 100%
100-199%
200-299%
300% +
70% below 200% FPL 84% below
200% FPL
Obama plan maintains Medicaid and SCHIP, but no details yet.
Proposals
Baucus plan extends Medicaid to all below 100% FPL and requires states to cover children in SCHIP up to 250% of FPL; higher levels required/permitted.
Key Issues
• Achieving national uniformity amidst state variation
• Financing public program expansions/improvements
• Assuring public programs work as they should in the context of universal coverage
Minimum Medicaid Income Eligibility Levels
133% 133%
100%
74%
0%
45%
0%
25%
50%
75%
100%
125%
150%
PregnantWomen
Children (0-5) Children (6-19) Elderly/Disabled Parents Childless Adults
Sources: B. Bruen, et al., “State Usage of Medicaid Coverage Options for Aged, Blind, and Disabled People,” Urban Institute (August 1999); and Kaiser Commission on Medicaid and the Uninsured, "Medicaid Eligibility for Families and Children" (September 1998).
Note: The income level for parents represents the median maximum AFDC payment level as of June 16, 1996.
Number of States that Cover Above the Federal Minimums
POPULATION NUMBER OF STATES
Children 51
Pregnant Women 45
Parents 25
Elderly/Disabled 20
Sources: D. Cohen Ross and C. Marks, “Challenges of Providing Health Coverage for Children and Parents in a Recession,” Kaiser Commission on Medicaid and the Uninsured (January 2009); B. Bruen, J. Wiener, and S. Thomas, “ Medicaid Eligibility Policy for Aged, Blind, and Disabled Beneficiaries,” Urban Institute (November 2003).
Source: D. Cohen Ross, A. Horn, & C. Marks, “Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,” Kaiser Commission on Medicaid and the Uninsured (January 2008);updated by the Center for Children and Families. Note: States with asterisks (*) have enacted, but not yet implemented to the levels shown.
FL
NC*
SC
GALA*TX
AL
AR
KS*
OK*AZ TN
MS
NVUT
NM
CA
WYID
WA*
ORND
SD
NE
MT*
MO
IN*
MI
WI
IL
ME
OH*
KY
HI
AK
PA
WV* VA
CTNJ
DEMD
RI
NHVT
DC
MA
CO*
IA*
NYMN
Medicaid and SCHIP Eligibility Levels for Children, January 2009
> 250% FPL (21 states)
200% FPL (16 states)
201%-250% FPL (9 states)
< 200% FPL (4 states)
Federal-State Partnership(State and Federal Spending on Acute Care, 2009-2014)
Sources: Center for Children and Families analysis based on Congressional Budget Office, “March 2008 Baseline: Medicaid” (March 11, 2008); and Congressional Budget Office, “Cost Estimate of H.R. 2 Children’s Health Insurance Program Reauthorization Act of 2009” (January 13, 2009). Note: SCHIP spending includes administrative costs.
Medicaid Spending
SCHIP Spending
State Dollars$758.1billion
$14.0billion
Federal Dollars
$1,005.0billion
$32.6billion
TOTAL$1,763.1
billion
$46.6billion
4 Out of 10 Medicaid Dollars are Spent on Medicare Beneficiaries
“Dual” Eligibles$133.3 billion
43.9%
Source: Urban Institute estimates based on data from the Medicaid Statistical Information System (MSIS) and Medicaid Financial Management Reports (CMS Form 64) prepared for the Kaiser Commission on Medicaid and the Uninsured, 2008.
Total Medicaid Expenditures = $303.6 billion
Unknown$11.6 billion
3.8%
Children$47.5 billion
15.6%
Adults$32.0 billion
10.5%
Other Aged and Disabled
$79.2 billion26.1%
Source: S.Dorn, et al.,”Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses,“ Kaiser Commission on Medicaid and the Uninsured, April 2008. Note: a 1% increase in unemployment also equals a 3-4% decline in state revenues.
Impact of Unemployment Growth on Medicaid and SCHIP
1%
Increase in National Unemployment Rate
=1.0
Increase in Medicaid &
SCHIP Enrollment
(million)
&
1.1
Increase in Uninsured
(million)
$3.4
$2.0
$1.4 State
Federal
Increase in Medicaid & SCHIP Spending
(billion)
Public Program Eligibility and Take Up for Children
Source: Background estimates for Julie Hudson and Thomas Selden, "Children's Eligibility and Coverage: Recent Trends and a Look Ahead," Health Affairs 26(5): w618-w629 (September 2007).
Take-up Rate 70.5% 78.3%66.4%
(Some) Other Issues
• Benefits• Access/payment rates• Integration among components• Quality standards/improvements• HIT